No study to date has examined the long-term impact of large scale terrorist events, such as the 9/1 1 attacks, in particularly vulnerable communities for whom long-time effects are more likely- such as the poor, minority, less acculturated, urban recent immigrants. The primary goals of this application are to identify risk and protective factors for the development and persistence of post-disaster psychopathology in a low-income, urban, primary care population; to determine the role of ethnicity and acculturation in the expression of physical and mental symptoms and in seeking post-disaster mental health treatment; and to explore the role of post disaster factors such as social support, and secondary stressors, in mediating the disaster effects over time. We have a unique opportunity to carry out such a study in a well established cohort consisting of a probability sample of 720 primary care, mostly Hispanic patients, who are residents of NYC and who have reported significant exposure to the 9/11 attacks, when they have been interviewed by our.research team 7-16 months after the 9/11attacks. These goals will be achieved through a follow up survey 4.5 years after 9/11 attacks. The proposed study will assist in planning for future disasters by providing longitudinal data collected from a systematic sample of NYC primary care patients, using state of the art measures that enable us to test theoretically guided hypotheses and to explore the relations between traumatic event experiences, sociodemographic characteristics, contextual variables, and mental health outcomes and service utilization.